Abstract
Goals of the work
The aim of this study was to examine the effect of nutrition intervention on outcomes of dietary intake, body composition, nutritional status, functional capacity and quality of life in patients with cancer cachexia receiving chemotherapy.
Patients and methods
Patients received weekly counselling by a dietitian and were advised to consume a protein- and energy-dense oral nutritional supplement with eicosapentaenoic acid for 8 weeks. The medical oncologist determined the chemotherapy protocol. Eight patients enrolled and seven completed the study.
Main results
There were significant improvements in total protein intake (median change 0.3 g/kg per day, range −0.1 to 0.8 g/kg per day), total energy intake (median change 36 kJ/kg per day, range −2 to 82 kJ/kg per day), total fibre intake (median change 6.3 g/day, range −3.4 to 20.1 g/day), nutritional status (patient-generated subjective global assessment score, median change 9, range −5 to 17), Karnofsky performance status (median change 10, range 0–30) and quality of life (median change 16.7, range 0–33.3). There were clinically significant improvements in weight (median change 2.3 kg; range −2.7 to 4.5 kg) and lean body mass (median change 4.4 kg, range −4.4 to 4.7 kg), although these were not statistically significant. Change in nutritional status was significantly associated with change in quality of life, change in Karnofsky performance status and change in lean body mass.
Conclusions
Nutrition intervention together with chemotherapy improved outcomes in patients with pancreatic and non-small-cell lung cancer over 8 weeks. Supplement intake does not inhibit meal intake.
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References
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376
Barber MD, Ross JA, Voss AC, Tisdale MJ, Fearon KCH (1999) The effect of an oral nutritional supplement enriched with fish oil on weight-loss in patients with pancreatic cancer. Br J Cancer 81:80–86
Bruera E, Strasser F, Palmer JL, Willey J, Calder K, Amyotte G, Baracos V (2003) Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: a double-blind, placebo-controlled study. J Clin Oncol 21:129–134
Capra S, Bauer J, Davidson W, Ash S (2002) Nutritional therapy for cancer-induced weight loss. Nutr Clin Pract 17:210–213
Davidson W, Ash S, Capra S, Bauer J, Cancer Cachexia Study Group (2004) weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer. Clin Nutr 23:239–247
Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11:8–13
DeWys WD, Begg C, Lavin PT, et al (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 69:491–497
Fearon KCH, von Meyenfeldt MF, Moses AGW, van Geenen R, Roy A, Gouma DJ, Giacose A, Van Gossum A, Bauer J, Barber M, Aaronson NK, Voss AC, Tisdale M (2003) The effect of a protein and energy dense, n-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: a randomised double blind trial. Gut 52:1479–1486
Forbes GB (1962) Methods for determining composition of the human body. Paediatrics 29:477–494
Isenring E, Bauer J, Capra S (2003) The scored Patient-generated Subjective Global Assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr 57:305–309
Jatoi A, Rowland K, Loprinzi CL, Sloan JA, Dakhil SR, MacDonald N, Gagnon B, Novotny PJ, Mailliard JA, Bushey TI, Nair S, Christensen B; North Central Cancer Treatment Group (2004) An eicosapentaenoic acid supplement versus megestrol acetate versus both for patients with cancer-associated wasting: a North Central Cancer Treatment Group and National Cancer Institute of Canada collaborative effort. J Clin Oncol 15:2469–2476
Martin C (2000) Calorie, protein, fluid, and micronutrient requirements. In: McCallum PD, Polisena CG (eds) The clinical guide to oncology nutrition. The American Dietetic Association, Chicago, pp 45–52
McCarthy D, Weihofen D (1999) The effect of nutritional supplements on food intake in patients undergoing radiotherapy. Oncol Nurs Forum 26:897–900
Moses AWG, Slater C, Preston T, Barber MD, Fearon KCH (2004) Reduced total energy expenditure and physical activity in cachectic patients with pancreatic cancer can be modulated by an energy and protein dense oral supplement enriched with n-3 fatty acids. Br J Cancer 90:996–1002
Nitenberg G, Raynard B (2000) Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol Hematol 34:137–168
Oettle H, Arnold D, Hempel C, Riess H (2000) The role of gemcitabine alone and in combination in the treatment of pancreatic cancer. Anticancer Drugs 11:771–786
Ottery FD (1996) Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 12 [1 Suppl]:S15–19
Splett PL (1996) Cost outcomes of nutrition intervention: part 2. Mead Johnson, New York
Stratton RJ, Elia M (1999) A critical, systematic analysis of the use of oral nutritional supplements in the community. Clin Nutr 18:S29–84
Vansteenkiste JF, Vandebroek JE, Nackaerts KL, Weynants P, Valcke YJ, Verresen DA, Devogelaere RC, Marien SA, Humblet YP, Dams NL; Leuven Lung Cancer Group (2001) Clinical-benefit response in advanced non-small-cell lung cancer: a multicentre prospective randomised phase III study of single agent gemcitabine versus cisplatin-vindesine. Ann Oncol 12:1221–1230
Acknowledgements
We gratefully acknowledge the support of The Wesley Research Institute (grant no. WRI-NR1-2000) and Ross Abbott Laboratories (study product). We are also grateful to Ms. Beverley Gallagher for assistance with data collection.
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This work was presented as a poster at the 16th MASCC International Symposium, Miami, 2004.
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Bauer, J.D., Capra, S. Nutrition intervention improves outcomes in patients with cancer cachexia receiving chemotherapy—a pilot study. Support Care Cancer 13, 270–274 (2005). https://doi.org/10.1007/s00520-004-0746-7
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DOI: https://doi.org/10.1007/s00520-004-0746-7